Considerazioni sui farmaci biologici nel trattamento della psoriasi a placche e loro impatto economico. Focus su etanercept

Abstract

Plaque psoriasis is a common inflammatory skin condition with a significant impact on quality of life and social costs. The prevalence of psoriasis is about 2–3%. Recent developments in systemic targeted therapies, like biological agents (anti-T-cell agents and inhibitors of tumour-necrosis-factor-α), have offered an alternative treatment approach which may translate into disease control and improvement of quality of life. The British Association of Dermatologists Guidelines (2005) stated that etanercept should be considered the first choice for patients with significant and stable psoriasis. A Consensus Paper of Italian Dermatologists has recently stated (2008) that, according to the ‘physiologic’ paradigm of selection among TNF-antagonists linked to more or less physiologic mechanisms of action, etanercept appears to be the anti-TNF of choice for treating most patients with moderate to severe plaque psoriasis and psoriatic arthritis, possibly even at an early stage. Etanercept, unlike other biological agents, is approved for the intermittent treatment (up to 24 weeks) of the psoriasis in Europe. Overall, the biological agents showed high efficacy in the treatment of patients who have not responded to other systemic therapies. No head-to-head studies comparing those agents are available in the peer-reviewed literature, but the economic impact showed higher cost of other biological agents compared to intermittent etanercept in the treatment of psoriasis. It would seem reasonable to state that intermittent therapy with etanercept results in a more contained budget impact in comparison to the other suitable biological agents for the treatment of psoriasis. Taking for granted the general recognition of innovation of the new biological therapies, the debate is now focused on the sustainability of the expense for these therapies by National Health Services. Considering this need, the saving opportunity offered by an intermittent biological therapy seems to be remarkable.